MEDICARE: MR. DAVID BRUCE KEENER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302026124	MI

General Provider Information

NPI Number	:	1548307572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID BRUCE KEENER RPH

Provider Business Mailing Address
First Line	:	823 W OAKRIDGE ST
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2753
Country	:	US
Telephone Number	:	248-545-3641
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E LAFAYETTE BLVD
Second Line	:	MC J103
City	:	DETROIT
State	:	MI
Zip	:	48226-2927
Country	:	US
Telephone Number	:	313-225-6356
Fax Number	:	313-225-4846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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